{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T23:48:32Z","timestamp":1768780112368,"version":"3.49.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2019,7,25]],"date-time":"2019-07-25T00:00:00Z","timestamp":1564012800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2019,7,25]],"date-time":"2019-07-25T00:00:00Z","timestamp":1564012800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2019,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Exercise training programmes (ETPs) are a crucial component in cardiac rehabilitation in heart failure (HF) patients. The Exercise Training in HF (ExTraHF) survey has reported poor implementation of ETPs in countries affiliated to the European Society of Cardiology (ESC). The aim of the present sub-analysis was to investigate the regional variations in the implementation of ETPs for HF patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>The study was designed as a web-based survey of cardiac units, divided into five areas, according to the geographical location of the countries surveyed. Overall, 172 centres replied to the survey, in charge of 78\u2009514 patients, differentiated in 52 Northern (n\u2009=\u200915\u2009040), 48 Southern (n\u2009=\u200927\u2009127), 34 Western (n\u2009=\u200911\u2009769), 24 Eastern European (n\u2009=\u200912\u2009748), and 14 extra-European centres (n\u2009=\u200911\u2009830). Greater ETP implementation was observed in Western (76%) and Northern (63%) regions, whereas lower rates were seen in Southern (58%), Eastern European (50%) and extra-European (36%) regions. The leading barrier was the lack of resources in all (83\u201365%) but Western region (37%) where patients were enrolled in dedicated settings and specialized units (75%). In 40% of centres, non-inclusion of ETP in the national or local guideline pathway accounted for the lack of ETP implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Exercise training programmes are poorly implemented in the ESC affiliated countries, mainly because of the lack of resources and\/or national and local guidelines. The linkage with dedicated cardiac rehabilitation centres (as in the Western region) or the model of local rehabilitation services adopted in Northern countries may be considered as options to overcome these gaps.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.1538","type":"journal-article","created":{"date-parts":[[2019,7,25]],"date-time":"2019-07-25T05:44:39Z","timestamp":1564033479000},"page":"1142-1148","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Regional Differences in Exercise Training Implementation in Heart Failure: Findings from the Exercise Training in Heart Failure (ExTraHF) Survey"],"prefix":"10.1093","volume":"21","author":[{"given":"Massimo F.","family":"Piepoli","sequence":"first","affiliation":[{"name":"Heart Failure Unit, Cardiac Department, G. da Saliceto Polichirurgico Hospital , Piacenza ,","place":["Italy"]},{"name":"Institute of Life Sciences, Sant'Anna School of Advanced Studies , Pisa ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Binno","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Cardiac Department, G. da Saliceto Polichirurgico Hospital , Piacenza ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew J.S.","family":"Coats","sequence":"additional","affiliation":[{"name":"Department of Cardiology, IRCCS San Raffaele Pisana , Rome ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alain","family":"Cohen-Solal","sequence":"additional","affiliation":[{"name":"Cardiologie, H\u00f4pital Lariboisi\u00e8re, UMR-S 942 , Paris ,","place":["France"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ugo","family":"Corr\u00e0","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istituti Clinici Scientifici Salvatore Maugeri, IRCCS Veruno , Veruno ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constantinos H.","family":"Davos","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens ,","place":["Greece"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tiny","family":"Jaarsma","sequence":"additional","affiliation":[{"name":"Department of Nursing, University of Link\u00f6ping , Link\u00f6ping ,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lars","family":"Lund","sequence":"additional","affiliation":[{"name":"Department of Medicine, Karolinska Institutet; and Heart and Vascular Theme Karolinska University Hospital , Stockholm ,","place":["Sweden"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Niederseer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University Heart Centre , Z\u00fcrich ,","place":["Switzerland"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Orso","sequence":"additional","affiliation":[{"name":"Heart Failure Clinic, Geriatrics and Intensive Care Unit, University of Florence and AOU Careggi , Florence ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni Q.","family":"Villani","sequence":"additional","affiliation":[{"name":"Heart Failure Unit, Cardiac Department, G. da Saliceto Polichirurgico Hospital , Piacenza ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piergiuseppe","family":"Agostoni","sequence":"additional","affiliation":[{"name":"Centro Cardiologico Monzino IRCCS, University of Milan , Milan ,","place":["Italy"]},{"name":"Department of Clinical Sciences and Community Health, University of Milan , Milan ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maurizio","family":"Volterrani","sequence":"additional","affiliation":[{"name":"Department of Cardiology, IRCCS San Raffaele Pisana , Rome ,","place":["Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Petar","family":"Seferovic","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Clinical Centre of Serbia, University of Belgrade School of Medicine , Belgrade ,","place":["Serbia"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,7,25]]},"reference":[{"key":"2026011721314980400_ejhf1538-bib-0001","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/ejhf.592","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). 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